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There are numerous American cities that stand out for certain characteristics. Madison, Wisconsin as a great place to bike. Cooperstown, N.Y., for the National Baseball Hall of Fame and Museum. Asbury Park, N.J., as the town where Bruce Springsteen got his start. The list goes on and on. Recently, San Francisco and Philadelphia, on opposite coasts, were characterized as standing out for similar reasons: the devasting consequences of addiction.

In San Francisco, for example, an area of Hyde Street has “an open-air narcotics market by day and at night is occupied by the unsheltered and drug-addled slumped on the sidewalk.” Twitter, the article notes, is only a 15-minute walk from there, and other giants of the technology industry are not far away. (Note that the previous blog post dealt with substance abuse in Silicon Valley, not far from the San Francisco area in this post.)

San Francisco’s “persistent homelessness” is a big problem for such wealth so close to it, and a large part of the homeless are the drug dependent. There are hundreds upon hundreds of heroin needles lying around, along with the people who shoot up. The dealers and users are known as “the street people,” or the street population. One resident said it’s like “the land of the living dead” and accuses the city of allowing a containment zone so that the devastation doesn’t spread. The police say the drug trade is their most significant issue.

The problem is so dire that in August, San Francisco health workers walked the streets to find opioid users and offer them Suboxone prescriptions, according to another article. The recipients can get the medication the same day. “At the end of a recent yearlong pilot, about 20 of the 95 participants were still taking buprenorphine under the care of the street medicine team.”

It’s estimated that 22,500 people “actively inject drugs,” and the San Francisco medical director said there’s a strong trend of people using both meth and opioids in the city, which is really difficult to treat. But the goal of going to the streets to find users is to reduce the number of deaths.

Almost three thousand miles away, Philadelphia is known far and wide as “the largest open-air narcotics market for heroin on the East Coast” and so it draws people from “all over,” according to an article that appeared in the New York Times magazine last October. In one neighborhood known as Kensington, which actually takes in other areas as well, dealers hand out free samples with impunity and those on drugs are using them in the open or are already passed out. It’s known as the Badlands and supposedly has the purest heroin in a three-state area.

The author rode through the area in 2017 with a special agent with the D.E.A. According to her description, it looks like the apocalypse hit there – “Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments.” Sadly, the largest provider of drug treatment programs in the Bay Area is the prison system.

There’s history behind why this neighborhood is the way it is, starting with the fact that it had cheap housing, and once people moved in and a drug haven started springing up around them, they didn’t have the money to leave. That story, and the individual stories, go on and on, and it’s just so sad. Kind of like San Francisco. Last January the governor signed a statewide disaster declaration—a public health emergency—to take concrete steps to try and address the devastation.

In the comments that appeared after the article, a San Francisco resident wrote in to say, “The article has allowed me to see how intractable our own ‘homeless’ problem in San Francisco will be without first addressing the drug epidemic….[It] shows what a death sentence heroin is, both for the users and for the community that the users (and pushers) inhabit. Why do we as a civilized, supposedly advanced society allow this?”.

If you need additional information on this matter or about Summit Rehab plans, please call us at (866) 569-9391.

Do the West Coast papers cover drug use in Silicon Valley to the extent that other publications do? Because it certainly seems to pop up in other media. Take microdosing, as an example. It’s a valid way to study the effect of a new medication on the body more safely than administering a full dose, but workers in the Valley are microdosing LSD, saying it makes them more productive.

An internet search on “microdosing + Silicon Valley” turns up articles in at least two publications (Forbes was writing about it as early as 2015) and on several websites: Business Insider, Huffpost, Medium, and The Independent and Wired from the U.K…but it took going to the SFgate website and searching to find an article on Silicon Valley and microdosing.

This Summit Estate Recovery Center blog first wrote about drug use in Silicon Valley last winter (2018), and it’s important enough subject to revisit it. At the end of the summer, a contributing writer for The New York Timeswrote an opinion article about a recent visit to the Valley and what she found. There are online and hardcopy headlines: “How and Why Silicon Valley Gets High” and “Turn On, Tune In, Start Up.” The writer had lunch with a couple entrepreneurs there, which were sad upates on the current state of affairs there. One lunchmate told her “that magic mushrooms will help …[her] become a better reporter … and … that Ecstasy will make …[her] a nicer person.” Seems he also suggested she try ayahuasca, a “brew made from plants that includes the hallucinogen DMT”. Soon afterward she learned that Tesla’s board was worried about company founder Musk’s admission that he has occasionally used drugs.

This was just before the popular Burning Man gathering, and she associated the festival with the use of ketamine. It sounded like that put her over the top:

“I spoke to just over a dozen people who all said consumption was increasing once again. Obviously, there are major problems with addiction to opiates and alcohol here, as elsewhere. But people in Silicon Valley tend to view drugs differently from those in places like, say, Hollywood and Wall Street. The point is less to let off steam or lose your inhibitions than to improve your mind.”

She quotes a tech worker as saying “It is all, about the ‘intellectualizing of drug use as a stimulant for the brain’ and refers to Michael Pollan and his book, “How to Change Your Mind,” about the resurgence of psychedelic drugs. He told her that “the exploration of drugs by tech workers remains part of the industry’s ‘hacking ethos’.”

A number of people commented on her article on their own blog. One wrote, “This is what you get when ordinary men aren’t calling the shots: society thinks nothing of pressuring unsexy men to work 200 hours a week, shooting up whatever drugs are needed to make Executive Chad’s arbitrary deadlines, using frickin’ hallucinogens for inspiration and friendship.” I won’t link to the post because he also makes misogynist comments and derogatory comments about one ethnicity.

The article itself had 229 comments on the paper’s website. Here’s one: “Is it any surprise that the gurus of AI and ‘the singularity’ would be taken in by pharmaceutical transcendence? Intelligence without thinking, ‘social media’ instead of culture, spiritual depth in a pill–it’s all about what sells, not what works. It would be funny if the world were laughing instead of throwing money at them.”

And here’s another: “I have always thought (and personally believed) that to expand one’s mind, first the person had to expand their empathy for all others. If you need a drug (natural or synthetic) with your sole purpose … to achieve some type of nirvana that will lead to you pushing yourself above another, then that sort of defeats the purpose, doesn’t it?”

You wonder about the future for these companies and their employees. Will things every change there? What will it take to turn it around? How do you change drug culture embedded in so many tech companies? How do you reach the hard-driving people at the top who are part of the problem if not the whole problem? And what about the individuals who are hurting themselves and their loved ones? What happens to them?

The holiday season is a happy and fun time for some people, and an anxious and nerve-wracking time for others. Many people love this season—the decorations, the well-wishers, the parties, food—the list goes on and on. Of course, this time of year has it challenges, too, such as the unrealistic expectations, the fatigue that sets in after yet another get-together…. But for people early in recovery, as well as those with a substance use disorder who haven’t taken action yet, the days and nights can be especially stressful. Here are some ideas for getting through the holidays with as little stress as possible.

For people in early recovery

— Know your triggers. If you think a work get-together will be too much and you’re not ready to answer why you’re not drinking, you don’t have to attend. Volunteering for a good cause and giving back that day may be a good substitute. Arranging get-togethers with other friends in recovery is another idea.

If you do go to a gathering and you’re offered a drink, you don’t have to look for excuses, you can just say “Alcohol doesn’t agree with me,” and leave it at that. Some experts recommend always having a glass in your hand filled with something like club soda and lime.

— Plan ahead. If you’re worried about seeing extended family or friends you haven’t seen in awhile, have a plan. Think about what you want to say beforehand on the subject of recently being in treatment (and now being in recovery) if people ask. If your family asks if they can have alcohol at the get-together, there is nothing wrong with saying you’d rather they didn’t. Yes, you will eventually have to face the fact that you’ll be in situations where others are drinking, but now is not necessarily the time. Your family may recognize that, especially if they have been in a family program.

— Remember self-care. The holidays may bring up any number of emotions that are difficult to deal such as painful memories, or guilt. Find healthy ways of coping. Take a walk, go to a movie with a friend, or do something else you enjoy. Call your sponsor, or go to a meeting and find a sober friend. Recognize that you may be vulnerable, and be especially mindful about depression. Don’t put your own needs aside. Keep stress to a minimum if you can, and don’t commit to too many responsibilities.

For people in not yet in treatment

If you haven’t yet made the move to do something about your addiction, the holidays can be stressful because of guilt. You know it weighs heavily on your family, and a family member or two may have spoken to you about an upcoming get-together and his or her fears or what’s expected of you. Perhaps you’ve been thinking about contacting a treatment center when all the hubbub is over. Whether you have a problem with alcohol, or suffer from a different substance or chemical abuse problem, think about whether your family would rather have you home with them or getting healthy. You can’t say “the children need you at the holidays,” if you’re not all there.

If you’re being truthful with yourself, you know your family would likely prefer to see you in treatment. This is not to say you should go for them; you should do it for yourself. And if you look at it long enough, you may just admit that saying your family wants you home is an excuse.

Here are the questions to ask yourself to determine whether or not you may have a problem and should seek help:

Have your friends and family members mentioned they’re about how much you’re drinking, or using another drug?

Is your drinking or substance or chemical abuse affecting your relationships or your performance at work?

Do you have an increased tolerance for alcohol or other drugs?

Do you get defensive when questioned about your drinking or other drug use?

Are you constantly planning for the next drink or time you can “use?”

Are you getting into legal trouble because of your drinking or other drug use? (Have you had a DUI, or been charged with disorderly conduct, for example?)

Have you been inappropriate at office parties or other gatherings?

Don’t wait to make that call or ask for help just because it’s the holidays. It could be the biggest gift you give yourself.

Dsuvia

There’s a new opioid in town called Dsuvia. It’s been all over the news lately, and it’s controversial. An NBC News headline proclaimed “FDA approves powerful new opioid in ‘terrible’ decision.” The FDA was also accused of bypassing its own advisory process to approve the drug.

This drug, which is 1,000 time stronger than morphine, is usually given in IV form. This new formulation is a tablet taken sublingually and is to be used only in health care settings such as hospitals. According to the NBC article, it’s commonly used on the battlefield and similar emergencies “to treat intense, acute pain.”. It was actually the military that requested the pill formulation.

In the middle of the opioid crisis, the obvious question experts are asking is do we really need another opioid? Two criticisms are that there may be more deaths from overdosing with this drug, and health workers in confined health settings may find it easy to steal it. The FDA, however, says it has learned from the opioid crisis and has tightly restricted Dsuvia. It will not be available at pharmacies or for home use, the package is for single-use only, and it should only be used for 72 hours tops.

Side effects, not surprisingly can be horrendous: fatigue, possible breathing problems, and even coma and death. The cost will be $50 to $60 per pill.

Test strips for Fentanyl

At the same time as a new opioid has been approved, there’s a new “tool” in the fight against opioid overdoses, according to several media outlets — a strip of paper that can test for fentanyl in batches of heroin. In October, The Atlantic reported a recent study found that drug users who employ them as a precaution before ingesting opioids or cocaine can possibly avoid overdosing.

Fentanyl is 50 times stronger than heroin and has been found in at least half of overdoses now. (As indicated, cocaine is often laced with fentanyl as well.) Researchers posit that if more people with substance use disorder had access to the strips, “they’d use less, or possibly not use … at all.” A YouTube video made by the Associated Press shows that when the strip is dipped into a drug, the appearance of two red stripes signifies fentanyl is present, and one stripe means it is not.

As we know, some states, and even cities, are more progressive than others. “… Baltimore; Philadelphia; Columbus, Ohio; and Burlington, Vermont—have started providing the test strips alongside clean needles. The California public-health department pays for the distribution of strips through needle exchanges.” Leave it to California to lead the way.

However, some health agencies have questioned the accuracy of the strips and whether or not a person would actually not take drugs they have right in front of them. Also, some experts want to see more research done.

There’s an obstacle as well: Some areas have “paraphernalia laws” that prohibit the use of devices to aid in doing drugs, except clean syringes, so these laws need to be amended to exempt test strips as well.

The cost may also deter some users. Each strip costs $1.00, and users take drugs on average four times a day, so it’s not a cheap aid for people who don’t have money.

The justice system has becomea lot more just lately when it comes to people suffering from substance use disorders by offering diversion programs that allow people who abuse drugs and commit crimes to avoid jail time by attending treatment and engaging in long-term monitoring. Certain professionals such as police, doctors, and lawyers have their own way of offering support to those willing to accept help.

Pilots in the throes of addiction are another group that has benefitted immensely from caring colleagues.Larry Smith, a former commercial pilot for Braniff and United Airlines who was addicted to several substances received incredible support from United Airlines, the FAA Medical Division, and the program for pilots calledHIMS(more about that later). Today he is CEO of Get Real Recoveryin San Juan Capistrano, CA, an FAA-approved treatment center he co-founded with his wife Lori in 2011.

Larry’s story is mesmerizing. In 1983 he received a DUI, although he was a furloughed pilot at the time. He received a second one that was reduced to a charge of reckless operation without alcohol. Larry now openly admits it should have been a DUI. He thought it was clever how he was able to duck under the radar for so long. Most alcoholics and addicts suffer from extreme denial, he says, and he was no different. Larry teaches that denial is the brain’s defense mechanism to protect the perceived right to use, not a character defect. Addicted people will use every type of denial possible to avoid being detected. They hide their pain and self-disgust with charm or anger, whatever is necessary. Larry sees himself in others at every intervention, counseling session, and group that he facilitates.

Larry’s addiction to alcohol started in 1965 at 14 years old. He started using cocaine occasionally in the 1980’s, and by 1998 he advanced to smoking crack. “I recognized I had a serious problem then, but I didn’t know what to do,” he recalls. He was afraid to turn himself in to the EAP or HIMS programs as he mistakenly thought he would be immediately fired if the truth about his chemical dependencies was exposed.

On February 3rd, 1999, a vice squad of 12 masked men with shotguns and riot batons used a battering ram to invade his home in Ohio. His arrest quickly made the national news. Smith was released from jail on February 5th and received a call from his chief pilot. He thought he was going to be fired, but instead, his boss offered him treatment. His first treatment center was too lenient with clients, so United’s EAP transferred him to Cornerstone of Southern California. He admits now, “I wasn’t a model patient; nevertheless, I fell in love with recovery!”

Nine months later Smith flew a 747 from SFO to Kona with 400 passengers on board. He gives all the credit to God and a forward-thinking airline. The FAA, United’s EAP and Management, an Aviation Medical Examiner, a psychiatrist and the Pilot’s Union (ALPA) all closely monitored Captain Smith’s progress for 5 ½ years. During this time, Larry became a licensed counselor and started speaking on addiction and the hi-jacked brain. Immediately after being released from FAA Monitoring, he spent eight years as a volunteer Union Rep to United Airlines EAP. Then and now, he guides and counsel pilots who abuse alcohol and drugs.

As the HIMS website explains: “The HIMS program was established to provide a system whereby afflicted individuals are treated and successfully returned to the cockpit under the FAA Special Issuance Regulations (14 CFR 67.401).”

It’s rigorous:

“The purpose of the HIMS program is to effectively treat the disease of chemical dependency in pilot populations in order to save lives and careers while enhancing flight safety. The HIMS concept is based on a cooperative and mutually supportive relationship between pilots, their management, and the FAA. Trained managers and peer pilots interact to identify and, in many cases, conduct an intervention to direct the troubled individual to a substance abuse professional for a diagnostic evaluation. If deemed medically necessary, treatment is then initiated. Following successful treatment and comprehensive continuing care, the pilot is eligible to seek FAA medical re-certification.

The FAA requires the pilot to be further evaluated by a specially trained FAA Aviation Medical Examiner (AME) who then acts as the Independent Medical Sponsor (IMS) to coordinate the FAA re-certification process. The medical sponsor provides oversight of the pilot’s continuing care. This care includes a monthly interview by a trained flight manager and by a pilot peer committee member, as well as periodic follow-up observations. Because of the relapse potential of chemical dependency, the monitoring will typically continue for several years after the pilot resumes his duties. The HIMS program is designed to ensure the pilot maintains total abstinence and to protect flight safety.”

Larry explains some of the challenges pilots face this way: “Pilots are great at following directions, like the checklist we give them in recovery, but they’re not so great at processing what’s within. We find that some had trauma in their early life. For example, some were at war, and some grew up with rigid fathers and co-dependent mothers and so forth, and counseling helps them see what may have caused them to drink and help them get out of their own minds.”

In 2010 he wrote The Daily Life Plan Journal, a goal-setting journaling guide for people in recovery to be able to simply draw lines on airplane-like gauges to assess their feelings and emotions. For example, instead of asking them to mark their flight level, they’re asked, What is your motivation level “right at this moment?” It’s an effective way to journal for people who don’t like to write or have difficulty expressing themselves in writing. This journal allows a person to simply put pen to paper and measure their feelings by drawing a line.

In addition, he wrote a book about overcoming addiction calledFlight to Transformation. The book is part memoir and part a strongly spiritual walk through recovery. He’s also expanding his treatment knowledge to include MAT–Medically Assisted Treatment, and the use of Stem Cells in recovery.

With all the evidence available, there’s no denying some employees have used drugs while working, whether they shot up in a restroom, or popped a few pills at their desk, for example. An article in The New York Times holds that ”As the opioid epidemic continues to rage…, the fallout is increasingly manifesting itself at construction sites, factories, warehouses, offices, and other workplaces.”

An earlier post on addiction in Silicon Valley mentioned that substance abuse in the workplace took place in offices there as well. But this article focuses on a construction worker, an employee in an industry that has been found in the past to have one of the highest rates of addiction of any field. Today it has “the second-highest rate of pain medication and opioid misuse after the entertainment, recreation and food business,” according to the article, and construction workers also have “twice the addiction rate of all working adults.”

According to an 11-year old survey by the National Safety Council, at the time, 70 percent of employers said that prescription drug abuse had affected their businesses, relating to absenteeism, injuries, accidents, and, of course, overdoses even then. Understandably, there were positive drug tests as well.

The construction worker in the article has overdosed on the job several times, and was revived with Narcan by a coworker at least twice. He never went to rehab, until he was fired and returned to his hometown. He joined the local construction union, which was a lifesaver. He had an outstanding arrest warrant which proved troublesome in getting him into a program, but union officials talked a judge into letting him serve his time in rehab. So far, he has been clean and is working, thanks to his union.

The current statistics are not good: in 2016, 217 workers died from overdosing on alcohol or other drugs at work, which was a 32 percent increase from 2015. Overdose deaths in workplaces have increased every year since 2010. That includes someone at Fiat Chrysler Automobiles, a crawfish fisherman in Louisiana, and a Sam’s Club warehouse worker in Texas. The guy down the street in your neighborhood, the man sitting next to you on the bus, or the father of a boy on your son’s little league team.

The article reports that few businesses are willing to acknowledge the drug use at their company. Yet certain enterprising business people do and are willing to help, like Alan Hart, president of Giovanna Painting in Spencerport, NY. Maybe it has something to do with the fact that he’s in recovery himself. He tries to help workers enter rehab, although he doesn’t offer employees health insurance. He also fires workers he suspects of abusing drugs while working.

It would be naïve to think drug use doesn’t go on in the workplace, and just like addiction can hit anyone, so drug use can appear in any business. Perhaps you heard of the teacher who OD’d in a school bathroom and died, although his wife had no idea he was on drugs. The news traveled as far as the United Kingdom.

In the corporate world, perhaps disseminating more information about Employee Assistance Programs would help. (For that matter, a comparison of programs would be a good thing, along with what laws mandate as far as offering employees treatment.) In addition, perhaps there should be guidelines for what employees can do if they suspect a co-worker of taking drugs, not as a punitive measure, but to try and address the problem. And of course, Narcan could be made available in workplaces. At least companies could discuss these approaches and others.

Addiction Treatment Centers

Leave it to California to take the lead when it comes to a group of hospitals trying a new way of helping those addicted to opioids—having ERs administer buprenorphine (aka Suboxone) when someone enters in the throes of withdrawal. (Lest anyone forget, buprenorphine is weaker than other opioids. It activates “the same receptors as other opioids, but doesn’t cause a high if taken as prescribed,” says the article in The New York Times.) A 2015 study by researchers at Yale-New Haven Hospital found that when ERs have done this, the people who get the buprenorphine are more likely (twice as likely, in fact) to be in treatment after a month than people who were only given an informational packet that included phone numbers related to treatment. As a result of the study, an ER specialist who heads the buprenorphine program at Highland Hospital in Oakland convinced the California Health Care Foundation to give his hospital a grant to try the novel method.

ER Departments

Out of the box idea? Sure. But it seems to be working. Now ER doctors are calling the lead author of the study every week, she said in August, and ER departments in Camden, NJ, Brunswick, Maine, Philadelphia, New York, Syracuse, and Boston are also offering buprenorphine.The doctors need training to prescribe the medication, as well as a license from the DEA to prescribe it unless someone is in withdrawal, so ER doctors are in a good position to treat those patients. “I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” the lead author of the study said. “They’re beyond thinking they can just be a revolving door.”

Treatment in the ER

It’s a rare opportunity to meet people where they need help and get them started on medication for their addiction, the article notes. In some places of the country, it’s not easy to find a doctor who takes insurance AND prescribes buprenorphine. After their ER visit, ideally a person will follow a “wheel and spoke” approach, where they first go to a treatment clinic (the hub), adjust to the medication, and then see a doctor in a primary practice (the spoke). Treatment in the ER involves buprenorphine under the tongue, and usually, a prescription for Suboxone, in the form of strips that will dissolve in the mouth and thus are harder to abuse. Then the person is directed to meet with the head of the addiction program in his clinic, where he’s available one day a week.

Detox Centers

Even signs posted in the waiting area of Highland ER reaching out to those suffering from opioid use disorder are helping. A woman there for a respiratory infection saw one and told her brother about the signs, and he decided to enter the program. Recently released from prison, he was hoping to stay clean, especially because he had a job offer. Now he had “a stable source of treatment.” California was willing to provide the grants to have this program flourish. Two-thirds of Highland Hospital’s 375 patients in withdrawal accepted the medication and had an initial appointment at its addiction clinic. Not only that, but California has started to require detox centers and residential centers to allow residents to take either buprenorphine or methadone, medication-assisted treatment, which has had a history of controversy. That’s also ground-breaking.

For more information or to contact our Detox Centers in the Bay Area call (866) 596-9391.

The number of people suffering from substance use disorder who likely think they won’t end up in jail is probably large—especially if they have good jobs. They never think it will happen to them. But it can. As a recent episode of the TV program Dopesick Nation showed, even formerly responsible citizens may find themselves stealing, forging prescriptions, and so forth to support their habit.

You may have heard we’re not doing nearly enough for substance abusers who end up in jail. But there are a few programs around the country that seek to help these people, often in small towns, that can serve as examples for other towns. Here are a few.

Peer recovery coaches in NJ

In one NJ town, certified peer recovery specialists are volunteering to work with those suffering from substance use disorder who are incarcerated. In a new program called Next Step, the volunteers are called coaches, and they help to steer prisoners into treatment.

Bail reform in certain areas of the country means that nonviolent offenders are being released earlier, and for addicts, that usually means without treatment or the offer of treatment. (And many [most?] likely got little help in jail.) Although it’s too soon to comment on the program’s success, shortly after the program was instituted at the jail, nearly half of those screened entered treatment.

One of the county prosecutors noted that when people are sent to jail, it’s often their lowest point, a good time to try and convince them that treatment may save their life. Several local organizations have stepped up to provide clinical assistance, including a social services organization helping inmates find jobs, a recovery center, a peer recovery organization and a hospital.

Having a peer in recovery work with an incarcerated person is another tool in the toolbox to help someone get healthy and return to society.

The Start Strong 3 E’s in Kentucky

There’s a new treatment program in the detention center in Kenton County, KY, in which inmates are expected to be “Employed, Enlisted, or furthering their Education,” 12 weeks after release, according to the program director. The key in this area, which has suffered greatly in the opioid addiction crisis? The jail is partnering with Aetna Better Health and getting help from the Hazelden Betty Ford Foundation.

The concept involves giving medication not only to quell cravings or ease withdrawal symptoms, but to stabilize patients getting therapeutic care in jail. They will then have the option to stay with medication assistance during and after their incarceration,according to a local TV station.And, luckily for these inmates, there’s an aftercare program with intensive job training.

Vivitrol and Counseling in Central New York State

In Onondaga County, NY, addicted inmates are given the opportunity to have injections of Vivitrol and attend counseling sessions.According to the Vivitrol website, the medication “is a non-addictive, once-monthly treatment proven to prevent relapse in opioid dependent patients when used with counseling following detoxification.”

Chicago’s Thrive program

Inmates suffering from substance abuse in a Cook County jail who are not in the drug court program are being offered naloxone on release and will be monitored “in a modified version of the sheriff’s electronic monitoring program.” (For example, caseworkers who worked with one woman on the inside will continue to work with her once she’s released.)

Other programs, in Indiana, Orange County, Florida, and Cincinnati, Ohio and Kings County, California, to name a few, show that a number of jails realize they can contribute to finding solutions to substance abuse in this country. Whether it’s to offer Suboxone, Naltrexone, Vivitrol, peer coaches, and counseling and job training, or a combination, these programs can serve as a blueprint for other jails.

Opiod Crisis

By now you have likely heard of the new book Dopesick: Dealers, Doctors, and the Drug Company That Addicted America by Beth Macy. Reviews are everywhere, and Macy appeared on radio station NPR and a PBS episode on TV this month. A reviewer at the Roanoke Times, where Macy once worked, says the book “humanizes the opioid epidemic.” And here’s the reason why it’s making news: he says “It is difficult to imagine a deeper and more heartbreaking examination of America’s opioid crisis than this new book by investigative reporter Beth Macy of Roanoke.”

Dope Sick

A reviewer in the San Francisco Chronicle says: “Macy reports on the human carnage with respect and quiet compassion, but it is gut-check reading.” Dope Sick, for the uninitiated, “is the slang term for being in withdrawal from opiates such as narcotic painkillers (oxycodone, hydrocodone, [morphine, fentanyl, or prescription opioids]) and heroin and refers to the symptoms you experience after stopping or drastically reducing opiate drugs after heavy and prolonged use (i.e., several weeks or more),” according to this website. It’s one of the things about addiction that has users going back to drugs, to avoid the horrible symptoms: nausea, vomiting, stomach upset, diarrhea, leg cramps restlessness, cold sweets, loss of appetite, lack of energy, lethargy, dilerium and …other signs…,” according to the Urban Dictionary. So it’s an apt term to use in the title of a book about the opioid epidemic. And what’s so horrendous, Macy says in the PBS interview, is that epidemiologists say we haven’t even hit the peak of the scourge yet; that’s not due until after 2020. Macy traces the history of the problem, and if you think to yourself, here we go again, you’re in for a surprise.

Addiction Treatment

What she says is really interesting. She points out that middle class Americans were able to hide what was happening longer. Parents didn’t want to tell their neighbors what was going on in their house, so the trouble was allowed “to fester and grow.” If you haven’t heard about some of the early heroes, she mentions a doctor named Art Van Zee who saw what was happening in Appalachia as more people got addicted and tried to get the attention of those in power. They didn’t listen. Macy also discusses the controversy over medication-assisted treatment (M.A.T.), and the TV viewer immediately understands how the “national divide” is not helping in fighting the problem. The PBS program stops in at an M.A.T program run by a former heroin addict to help make her point. Here’s how Macy explained the divide in a 2016 article: “Among public health officials, the effectiveness of M.A.T. has become an article of faith; after all, treatment with buprenorphine and methadone has been found to cut opioid overdose deaths in half when compared to behavioral therapy alone, and it’s hard to argue with that. An addict treating his opioid disorder with Suboxone, many argue, is no different from a diabetic taking insulin.

Addicts & Their Families

But increasingly, law enforcement officials — and many former addicts and their families — are lining up on the other side, arguing that Suboxone only continues the cycle of dependence and has created a black market that fuels crime.” Here is a more recent article Macy wrote about part of her book. She starts with a call she got from a mother whose addicted daughter was found murdered. Macy had been following the daughter’s story for a couple of years. The woman was taking Suboxone again and was supposedly on her way home to Roanoke from Las Vegas, but was found dead in a dumpster after she didn’t arrive. As the mother had said on the PBS program, it’s hard to know when to offer help to an addicted child and when to push away, for your own good and for the good of others. There’s always a story about a mother and a child in this epidemic, and it never gets any easier. At the end of the program, Macy says that she’d like to mobilize people to care. There have been a number of books written about the opioid epidemic, but if you read just one book about it this year, make it this one.

Can the news from the Centers for Disease Control about 2017 drug overdoses BE any bleaker? The years 2016-2017 saw a record number of people dying from overdoses, which was more deaths than from guns, car crashes, or H.I.V.

Someone has done an analysis. Drugs are deadlier now (often due to mixing them with other substances besides the main drug), and more people are using. The good news is that where the deadlier drugs arrived earliest, such as in New England, some states are seeing the number of overdoses drop. Could that be from diligent public health campaigns and offering more addiction treatment, which they were hitting the problem with?

However, the writer reminds readers that you can’t totally trust the numbers. With an epidemic like the Zika virus, an infectious disease, people sought help, and public health officials moved, quickly. But with addiction, there’s that pesky STIGMA (detailed in an earlier post on this site this month), so that drug users may not have been truthful about their drug use when polled. Also, some drug users don’t have telephones or are hard to reach, and some deaths take longer to be researched and reported than others.

Deaths from Drug Addiction

As mentioned earlier, another reason for the astronomical number of deaths is that the drug supply is changing, as noted by an associate professor at the Brown University of Public Health. Fentanyl is being added to heroin, methamphetamine and cocaine, and even anti-anxiety medicines known as benzos, or benzodiazepines. (Stay tuned for a post on older people mixing benzos with opioids.) That’s especially bad news for “older, urban black Americans; those who used heroin before the recent changes to the drug supply might be unprepared for the strength of the new mixtures,” according to the article.

The East seems to be in a better position than the Midwest relative to this one part of the epidemic, because heroin that makes it way to the West is usually “processed into a form known as black tar that is difficult to mix with synthetic drugs.” The East, however, usually has a white powder that combines well with fentanyl.

Let’s hope that Dayton, Ohio, which has been in the news as a “hot spot” for opioid use, is the way of the future for other states. The county has a new emergency response strategy, is utilizing federal and state grants to combat drug use, and has reduced opioid prescribing and provided addiction treatment to prisoners in jails.

Drug Addiction Treatment Centers

There are other hopeful signs: Congress may step in with bills that mandate reductions in prescribing opioids, among other things, and along the same lines, experts are reminding people that we need more funding of public health programs.

There’s yet another action that might help which requires no funding and little effort. A behavioral economist at the University of California and the Chief Medical Examiner-Coroner for Los Angeles County wrote an opinion column to suggest that medical examiners and coroners tell doctors when their patients die of overdoses. They wrote that they believe that more careful prescribing would result if doctors were told, and they even set up a trial in San Diego County in 2015 to test their thesis.

They had a letter sent to half the doctors in the study who had prescribed opioids about that doctor’s patient’s death after each one happened. The letter wasn’t threatening “and gave the clinician a path toward safer prescribing.” The results of the study indicated doctors did reduce their prescribing and started fewer patients on opioids.

If you have PPO coverage from a major insurance provider, your treatment may be covered. We are unable to accept Medi-Cal, Medicare, Medicaid, Tricare, Kaiser, Healthnet or Humana at this time.

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